A Nurse Practitioner On LGBTQ Health And Why #WeNeedAButton

Eddie Meraz grew up in a rural area of Washington state. After college, he worked in social services and did case management, working with HIV/AIDS organizations in Seattle.

“I was an idealist,” says Meraz. “I came out of college wanting to help the community and I wanted to work within the gay community, so that was important. I moved to San Francisco and started working with nurse practitioners who were HIV specialists and primary care providers. I realized that I wanted to do what they were doing. So I went back to school.”

Meraz attended the Yale School of Nursing in Connecticut and then had the pull to come to New York City, like many people do. “It’s magnetic,” Meraz says. He’s been living in New York City and working as a nurse practitioner and HIV specialist for 11 years.

What is a nurse practitioner exactly?

Nurse practitioners have a nursing degree, a registered nursing license and they also have to have a master’s degree. While they technically aren’t doctors, they have the ability to see patients, make diagnoses, and prescribe medications without the direct supervision of a doctor.

“I did a two-year fellowship after obtaining my master’s, which is not common for a nurse practitioner,” Meraz explains. “But I got lucky because I wanted to specialize in HIV medicine. I now work as a primary care provider. I take care of a lot of people who are HIV positive and manage their care.”

While he specializes in HIV-related care and treatments, Meraz is well-versed in gay men’s health in general. He offers gender-affirming care, and works with all types of patients.

What is primary care, you ask?

Primary care is essentially a long-term relationship with one provider who you can see for urgent care issues, but more importantly, who you see for chronic care and to promote your longterm health.

“I’ve fallen into the primary care specialty mostly because I like establishing relationships with people and helping people maintain their health over time,” Meraz adds.

“I try to focus on longterm issues and goals with my patients. How are you going to prevent heart disease? How are you going to prevent cancers? How are you going to get appropriate screenings? How are you going to manage your mild depression? How are you going to manage your diabetes? I’ve fallen into the primary care specialty mostly because I like establishing relationships with people and helping people maintain their health over time.”

When told about the #WeNeedAButton initiative, Meraz responded by saying that even he too has had his own negative experiences with medical professionals.

“Even as a working healthcare professional and seeking care from another provider, there’s been some negative experiences,” Meraz admits.

“It speaks to the bigger problem, right? This is a bigger social issue. Even in New York City you can find medical providers who are not capable or not trained or unwilling to become culturally competent in working with people who are LGBT or queer. It happens. I have people who come see me as their primary care provider because they were treated horribly by someone or judged or they weren’t able to get access to PrEP or their needs were minimized when it came to sexual health or they’re they didn’t feel welcome or affirmed when they were seeking gender affirming therapies.”

“They’re probably saying things to other people too.”

Meraz asks us to think of the implications of medical professionals’ inappropriate behavior. He says it quite likely extends far beyond the LGBTQ community.

“I wouldn’t be surprised at the people who are so lax with their language in saying something hurtful would also be lax in their language with other people. You know what I mean? I think it all comes down to just being able to work with human beings and being respectful about where people are coming from. I think some people take for granted the fact that our patients look up to us and are asking for help. Patients are putting themselves in a vulnerable position, however they identify or however they present. I think unfortunately, many providers –who may be overworked or maybe they just don’t have the cultural sensitivity or an emotional intelligence – aren’t picking up on how careful we must be in communicating and talking to people. My assumption is that if somebody is saying inappropriate things to a gay patient, they’re probably saying things to other patients as well.”

Providers need to ask the right questions.

“We can certainly create a more welcoming environment,” Meraz says. “At our office for example, before a patient even comes to see us, we ask what personal pronouns they prefer. We ask everyone the same kind of questions of how they identify, who their partners are, if their partners are female, male or trans/non-binary. We try to collect the information and try to keep it as inclusive as possible as a way of just saying hey, we’re open to discussing all forms of sexuality here at our practice. But these are the questions that need to be asked, right? Because it does dictate prevention counseling. It does dictate health maintenance. It does dictate quite a few things on how we should direct care.”

Medical professionals need more trainings!

“In nursing school, we had some cultural competency, but it was like, a few lectures. I think it definitely needs to be something that should be focused on more on a regular basis,” says Meraz. “Doctors, nurse practitioners, PAs, we should all be taking continuing education courses throughout our careers. We should never stop learning. I think it may be helpful to include cultural competency as part of continuing education.”

In each of the practices Meraz has worked at, cultural competency training was included. Sometimes it was to focus on racial disparities and sometimes it was focused on gender-affirming care, sometimes it just focused on gay men’s health or lesbian health.

“Continuing education, especially when it comes to cultural competency, needs to be something that the institution or the employer values and some institutions are going to value this more than others. I think the larger the institution, the more likely that there will be cultural competency training because it is important to more and more people.”

The work is never done.

“The reality is none of us should never get to a place where we feel like we’ve stopped learning, right?”

Things are always changing. Meraz is lucky to work alongside colleagues who are open to expanding their worldview. “The big thing that I’ve noticed is that my colleagues are open to learning more. And in doing that we have to create space and time to teach people, and allow people to talk about what their own barriers are. We need people to talk about their own limitations and be open about the fact that not everybody’s going to have the same skill-set and that’s okay. Some people are going to have more information or already have enough training, we just need to start where everybody’s at. I’m not going to fault somebody who knows nothing but is eager to learn, you know?”

Even Meraz has had to learn, grow, and change with the times. “I’ve been educated by my patients on how language has evolved and how I should evolve. Like using terms like gender-affirming care rather than trans therapy, which was acceptable a few years ago.”

Meraz works diligently to keep on top of medical and cultural shifts around queer, trans, and non-binary medicine. This includes participating in trainings and attending conferences focused on specific issues of care.

“Some medical providers live in a bubble of medicine and taking care of people. It’s up to us to continue to keep our fingers on the pulse. That can be challenging, but it’s absolutely necessary if we’re going to deliver quality care to all of our patients.”